Provider Demographics
NPI:1558655910
Name:1ST IMPRESSION DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:1ST IMPRESSION DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-817-5799
Mailing Address - Street 1:3901 W GREEN OAKS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2795
Mailing Address - Country:US
Mailing Address - Phone:817-704-3767
Mailing Address - Fax:
Practice Address - Street 1:3901 W GREEN OAKS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2795
Practice Address - Country:US
Practice Address - Phone:817-704-3767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty